开立内镜联合京都胃炎分类在胃幽门螺杆菌诊断中的应用效果分析

Analysis of the effectiveness of SonoScape endoscope combined with Kyoto gastritis classification in diagnosis of Helicobacter pylori in stomach

摘要:

目的 探讨开立内镜联合京都胃炎分类在胃幽门螺杆菌（Hp）诊断中的应用效果。方法 于开立胃镜下观察胃黏膜，采用京都胃炎分类进行评分，结合快速尿素酶Hp检测，综合评价开立内镜的诊断效能，对基于快速尿素酶与开立胃镜观察的胃黏膜各表现做多因素分析。结果 开立内镜联合京都胃炎分类对Hp的诊断效能相对于快速尿素酶的诊断准确性更高［曲线下面积（AUC） = 0.913，95%CI：0.884～0.943，灵敏度为92.20%，特异度为90.50%，约登指数（YI）为0.827］。开立内镜SFI模式观察弥漫性发红的诊断相对于快速尿素酶准确性更高（AUC = 0.893，95%CI：0.859～0.927，灵敏度为86.80%，特异度为91.30%，YI为0.781）。开立内镜观察下诊断的55例胃肠上皮化生黏膜中，病理报告胃肠上皮化生阳性的例数为46例，阳性符合率为83.64%。单因素分析结果显示，年龄、患者类型、检查类型、彩图数、萎缩、胃肠上皮化生、皱襞肿大、鸡皮样黏膜、弥漫性发红和京都胃炎评分是开立内镜联合快速尿素酶检测Hp感染的影响因素（P < 0.05）。多因素Logistic回归分析结果显示，开立内镜观察下的萎缩（OR＾ = 19.725，95%CI：7.205～54.004）、胃肠上皮化生（OR＾ = 11.103，95%CI：1.378～89.452）、鸡皮样黏膜（OR＾ = 89.534，95%CI：9.124～870.055）、弥漫性发红（OR＾ = 61.793，95%CI：23.278～160.920）、京都胃炎评分2分及以上（OR＾ = 1.123，95%CI：1.025～1.610）是影响开立内镜联合快速尿素酶检测Hp感染的独立危险因素，Hp阳性诊断的效能排列为：鸡皮样黏膜 > 弥漫性发红 > 萎缩 > 胃肠上皮化生 > 京都胃炎评分2分及以上。结论 开立内镜联合京都胃炎分类在上消化道Hp诊断中的诊断效能较高，其SFI模式对弥漫性发红的观察有一定优势，VIST模式对发红肠化的判断有较大优势。多因素分析显示，开立内镜观察下各项指标及Hp诊断结果与京都胃炎分类基本一致。

Abstract:

Objective To investigate the effectiveness of SonoScape endoscope combined with Kyoto gastritis classification in diagnosis of Helicobacter pylori (Hp) in stomach.Methods Use the SonoScape endoscope to observe the gastric mucosa. The gastric mucosa was scored using Kyoto classification of gastritis, and the presence of Hp infection was judged. Combined with rapid urease Hp detection to comprehensively evaluate the diagnostic efficiency of SonoScape endoscope. Combined with rapid urease and gastroscope observation of gastric mucosal manifestations, multivariate analysis was performed.Results Compared with rapid urease, the diagnostic efficiency of SonoScape endoscope combined with Kyoto gastritis classification for the diagnosis of Hp was better [AUC = 0.913, 95%CI: 0.884 ~ 0.943, the sensitivity was 92.20%, the specificity was 90.50%, and the Youden index (YI) was 0.827]. The diagnosis of diffuse redness observed by SonoScape endoscope SFI mode was better than that of rapid urease (AUC = 0.893, 95%CI: 0.859 ~ 0.927, the sensitivity was 86.80%, the specificity was 91.30%, the YI was 0.781). Among the 55 cases of gastric intestinal metaplasia of gastric mucosa diagnosed under SonoScape endoscope, 46 cases were positive for gastric intestinal metaplasia reported by pathology, and the positive coincidence rate was 83.64%. Univariate analysis showed that age, patient type, examination type, number of color pictures, atrophy, gastric intestinal metaplasia, fold enlargement, chicken skin-like mucosa, diffuse redness, and the Kyoto classification score of gastritis were statistically different in the rapid urease test significance (P < 0.05), which were the influencing factor of Hp infection. In multivariate Logistic regression analysis, atrophy (OR＾ = 19.725, 95%CI: 7.205 ~ 54.004), gastric intestinal metaplasia (OR＾ = 11.103, 95%CI: 1.378~89.452), chicken skin-like mucosa (OR＾ = 89.534, 95%CI: 9.124 ~ 870.055), diffuse redness (OR＾ = 61.793, 95%CI: 23.278 ~ 160.920), Kyoto classification score of gastritis with 2 or above (OR＾ = 1.123, 95%CI: 1.025 ~ 1.610) were independent factors for the positive detection of Hp by rapid urease combined SonoScape endoscope. The efficiency of Hp positive diagnosis was ranked as follows: chicken skin-like mucosa > diffuse redness > atrophy > gastric intestinal metaplasia > Kyoto classification score of gastritis with 2 and above.Conclusion SonoScape endoscope combined with Kyoto gastritis classification, compared with rapid urease detection, has a good diagnostic performance in the diagnosis of Hp in the upper gastrointestinal tract. The SFI mode has certain advantages in the observation of diffuse redness, the VIST mode has a greater advantage in judging red gastric intestinal metaplasia. The multivariate analysis shows that the observation indicators and Hp diagnosis results under SonoScape endoscope are basically consistent with the Kyoto gastritis classification.